In seeking to meet BP goals, strong evidence base to draw on

The release of the new hypertension guideline from a joint task force formed by the American College of Cardiology and American Heart Association has brought heightened awareness to the management and control of blood pressure (BP). Fortunately, there are evidence-based recommendations that physicians and their practice teams can follow to better identify patients with hypertension and help get them to goal.

Here are our top three stories covering guidelines and evidence for hypertension management and control covered by AMA Wire® in 2017.

Multiple studies have made it abundantly clear that hypertension is a major health problem in the U.S. and around the world. An estimated 80 million Americans—about one-third of the adult population—suffer from hypertension, putting them at increased risk of strokes, heart attacks and other disorders. A recent article in The Journal of Clinical Hypertension provides a framework to optimize accurate blood-pressure readings and boost patient adherence to treatment. It should help physicians enhance management of hypertension.

The article outlines the “measure accurately, act rapidly and partner with patients” approach to hypertension management. The foundation for the paper is the recognition that primary care physicians cannot do it all. They need to work more effectively with medical assistants, nurses and other members of practice team, said Romsai T. Boonyasai, MD, MPH, assistant professor at Johns Hopkins University School of Medicine and a member of the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The article describes a team-based approach for treating patients with hypertension.

Nearly half of American adults, 46 percent, will be determined to have hypertension under a new clinical guideline on the prevention, detection, evaluation and management of high BP, up from 32 percent under the old benchmark. Previously, high blood pressure was defined as BP readings persistently at or above 140 mm Hg systolic or 90 mm Hg diastolic, but is now defined as persistently at or above 130/80 mm Hg.

This new guideline does not mean these newly classified patients with hypertension will face dramatic new risks or that physicians need to immediately begin medication treatment for most. The guideline is meant to prevent strokes, heart attacks and other cardiac problems through earlier action—a combination of lifestyle changes for all of these patients, and medications for some, depending on the circumstances—to control high BP.

This story from July, published prior to the new guideline systolic BP goal of 130 mm Hg, drew on the recently published results of the Systolic Blood Pressure Intervention Trial that showed significant benefits of a BP target of less than 120 mm Hg. For patients at risk for stroke, it was shown that a BP treatment goal of less than 130 mm Hg had the strongest benefit, according to the study.

For patients with hypertension, it’s important for physicians and other health professionals to communicate as explicitly, yet nonjudgmentally, as possible about needed lifestyle changes. These may include adherence to drug therapy regimens as well as dietary modifications and an uptick in physical activity. A diet rich in fresh fruits and vegetables, whole grain, low-fat dairy, poultry, fish and plant-based oils, and that is also low in sodium and sugar intake has been shown in randomized controlled trials to lower blood pressure as effectively as antihypertensive medications. That is the basis for Dietary Approaches to Stop Hypertension (DASH) diet.

Furthermore, for patients with hypertension who are overweight, the single most effective approach to lowering BP is weight loss, said Dr. Boonyasai. “We always emphasize cutting out salt, for which we can expect a reduction in systolic blood pressure of 2 mm Hg, but eating a DASH diet or losing weight can reduce systolic blood pressure by 10 or even 20 mm Hg,” he noted.

As critical as it is to achieve accurate BP measurements in the office, a study published this year found that it is the rare medical student indeed who has mastered how to properly perform this vital task. At a medical conference, 159 medical students volunteered to take part in a blood-pressure check challenge. Individually, students went into a mock exam room where a patient actor sat, legs crossed, on an elevated stool with no arm, back or foot support.

The results were “disappointing,” study authors said in an article published in The Journal of Clinical Hypertension. Just one student scored 100 percent. On average, students performed 4.1 of the 11 skills correctly. The “Blood Pressure Check Challenge” was held at the 2015 AMA Annual Meeting.

“Given these students represented schools in 37 states, the results suggest it is unlikely that current U.S. medical students are able to perform reliably the skills necessary to measure BP accurately,” the study authors wrote.

The Million Hearts Hypertension Control Challenge is a federal competition to identify clinicians, practices and health systems that have achieved a hypertension control rate of 70 percent or greater among their patients with hypertension and award them with recognition for their work. Learn about the 2017 Hypertension Control Champions.

Target: BP™ is a national initiative co-led by the American Heart Association and the AMA. In addition to direct access to trained field support specialists, a data platform and a suite of evidenced-based tools and resources offered by the AMA and the AHA, Target: BP offers annual, recurring recognition for all participating sites that achieve hypertension control rates of 70 percent or higher among their adult patient population year over year. Learn about the 300-plus organizations recognized by Target: BP.